Blood Work

I can’t stand getting my blood drawn. This phobia does not extend to needles in general, as I don’t mind shots, but getting a lab slip for blood work is a doomsday sentence for me. This is more unfortunate for my circumstances than for the average person, because my health conditions necessitate frequent routine draws. I’ve trained myself out of my fear of flying, fear of men post-attack, and other phobias over my life, but this one seems impossible to conquer.

This fear confuses me. I’ve tried to analyze it, somewhat unsuccessfully, because there are still gaps in my understanding. For example, I’m not directly afraid of anything specific about the process of blood work. In contrast, when I was afraid of flying, I was terrified that the plane would blow up in a fury of flames at take off as it built up speed. I could also explicitly point to anxiety that turbulence was “abnormal” and the plane was going to lose its lift and plummet. I reasoned my way out if these through research, which was one step that helped me conquer the gripping phobia I had. I can’t identify a cognitive (even if flawed) reason for my blood draw issue. I’m not afraid of anything bad happening: I don’t think I’ll bleed out, I don’t think the phlebotomist will damage my body in some way. Sure, it hurts, but I’ve faced many significantly more painful situations, so I don’t think it’s that. I have had several bad experiences (passing out and hitting my head because they sent me on my way too quickly, waking up another time after fainting and not understanding where I was and then panicking, and incompetent nurses or techs that had to stick me several times when they themselves panicked due to an issue with the stick, but again, nothing Earth-shattering compared to other actual traumas I’ve faced. I think part of my anxiety is that I do feel sick and lightheaded with bloodwork, but I think some of that is physiological (as I’m chronically anemic and hypotensive so I do get weakened), but it’s undoubtedly also the anxiety feeding into the physiological anxiety reaction in a chicken-and-egg self-fulfilling prophecy. The more worked up I get, the worse I start to feel, and that in turn, makes me feel more uneasy and panicked. Ever since my attack, the number-one trigger that sends me into a PTSD bout is not feeling well or, more precisely, experiencing unaccustomed or unwarranted feelings in my body. I haven’t really divulged the details of my attack here yet because it hasn’t seemed necessary and it’s quite upsetting and emotionally shaking for me to actually think about it in a detailed way. Instead, when I say “my attack,” it couches the severity of the trauma into an emotionally safer package for me. One that has become such a habitual term that I can sort of displace myself or disengage from the feelings around that day. Just saying “attack”, doesn’t fully conjure up the utterly devastating and heinous acts I survived. I’ve recently been starting targeted trauma therapy though and my therapist thinks I would benefit from talking more explicitly about what happened, as a way to get some of terrifying memories that monopolize my brain. I do occasionally talk about it in detail with my mom or Ben, but even with them, it’s generally just mentioned in passing using the globalized “attack” terminology. Anyway, I’m leading myself quite a distance from my intended topic, and thus is more of a post for another day because I’d like to continue to evaluate my lab work phobia, but the point of my digression was to confess that my physical feelings of “unwellness” fuel my PTSD because I was so severely injured during the attack that I was genuinely worried I was going to die. Unfortunately (for once), this wasn’t even all inflated by my anxiety. Anyway, I think consequently, as I kind of was operating in survival mode for the first few days afterward, stunned pretty much into silence, not working or really doing anything, I just had me and my body and it didn’t feel right and I felt unsure if I was actually going to still make it through. Even though the acuteness of the trauma was over, I felt broken in so many ways and there was no clear path, however distant, to my guaranteed recovery. Over the first few days, I started healing physically but deteriorating emotionally. I’d check my own pulse periodically to see if my heart was still beating. While thankfully I’ve never come even within earshot of that sort of physical and mental trauma since, it takes a much smaller stimulus now to shove me back into that am-I-really-going-to-be-ok? place. Although I’m countless levels tougher than I ever was before, I’m a baby when it comes to triggering feelings.

Still, I don’t know that any of that necessarily plays any more than a correlation role in my blood draw anxiety. I don’t think it’s a cause. The one piece that I do think must have some effect on the phobia is that after I lay on the floor post-attack, I was bleeding profusely and I was fighting to maintain consciousness while my body seemed to want to pass out. I was alone, except for my dog, and my phone had been ripped from my hand and thrown behind the couch, so I was pretty removed from life lines. I was too shaken to scream. I knew if I succumbed to the faint, I could potentially bleed out eventually and part of me, in that moment, was okay with that, as I saw no possible way I’d be able to pick myself up literally and figuratively after this and pull together some semblance of dignity and strength to move on. I actually credit my dog for convincing the piece of me that was willing to fight to prevail. She came slinking out of the corner where she had been hovering by the door around the turn in our hallway, out of sight. Slowly, I heard her nails ticking on the floor toward me. She was crouched and sling-backed and the hair on the back of her neck was raised. Even though he was gone and had slammed the door in front of her, she wore every color of fear. As she got within arm’s length of my body, she stopped and looked at me as if seeking approval to enter the invisible outline around me. I stared back at her, barely recognizing her for a minute. I remember thinking in my head, “wait, who’s that?” Unable to lift my heavy head yet, I simply tapped my own finger on the floor. She could read me. Come. She gingerly came forward and sniffed me. Then, in Gross Comet fashion, tried to start licking blood on the floor. That was the moment that finally I cried. It’s also the moment I decided I needed to find a way to get up, and while I’ll detail that struggle another day, I do think she played an instrumental role in me fighting my body’s protective urge to pass out and helped me save myself. Now, I think I’m particularly conditioned to fear even whispers of lightheadedness and fainting. I can’t stand that feeling. I want to be as far from it as possible because it immediately puts me back into that very worst of all my catalogued memories (and I have a very detailed and vast collection stuffed in my brain). It becomes so real; it’s as if I’m transported back to that wooden floor, plastered in terror, deciding what to do, realizing with each passing moment that I was one breath further from the person I had always been and one more into one that was frighteningly foreign: a life I didn’t know I could or wanted to bear.

I do genuinely want to rid myself of this fear. On Friday, I had to get blood work for my preoperative appointment to fix a bone in my foot. To try to quell the anxiety before it had time or momentum to build, I tried employing all sorts of relaxation and distraction techniques prior to arriving: mindfulness meditation, listening to music, deep breathing, talking on the phone, playing games, progressive muscle relaxation, even bribing myself with the promise of a reward on my Amazon wish list for getting through it. Nothing really worked. My heart was thumping and I was overheating just waiting to be called in. I tried talking to the old lady sitting next to me, something wildly outside of my comfort zone, but my brain just kept honing back in on blood work. When the nurse calmed me in, I gave a sheepish smile and tried to walk bravely over to the table. My eyelids filled will tears. They filled to their capacity before the volume exceeded the force from the surface tension holding them in. They rolled onto the paper pillow and spread like cracked eggs. She asked me my name and my voice cracked, the lump lodged in my throat hindering the ease of my most familiar word. I just swallowed. I couldn’t speak. She then looked up from her clipboard and noticed how I’d quickly melted into an emotional heap, entering the room as a young woman and now a small frightened child. She even commented I was smaller than but reminded her of her nine-year-old daughter.

Eventually, I was able to find my voice and string together enough coherent language to answer her questions and assure her I was fine, just scared of lab work. And so we began. I wish I could say it went well, but this blog is all about honesty and my reality, in all its highs and lows, mistakes and weaknesses. It did not go well and I was not the brave solider I fully intended to be. I’m unparalleled in my ability to imitate and emulate behaviors and personas in most cases (in fact, it’s one of my qualities that helps me camouflage amongst neurotypicals and evade diagnosis for so long), yet I was entirely unsuccessful in terms of willing myself to act unphased by the draw. I cried and cried. To my credit (if I can even say that in this case), they did have to get three nurses and try the stick three times because my veins kept rolling, but I still should have played a more stoic role. After the first puncture, the nurse panicked and called another over for an assist. The superior said, “oh, it rolled…no problem.”

They continued to try to rectify the draw and since I don’t look, I envisioned the worm-flipping feeling in my forearm to be part of the sample collection process. It was incredibly uncomfortable and interspersed with sharp transient flashes of pain. Then, it stopped. I felt the needle recede from my skin and the gauze applied with heavy pressure. “All done,” she said. “That was terrible,” I cried, but breathed a sigh of relief that it was behind me.

As I sat there trying to get ease my heart rate back down, I started thinking about some of my challenges and wondering if the sensory issues play a role in my body’s repulsion to the whole blood drawing experience. The textured astringent wipe that is intended to sterilize the skin creates a toe-curling offensive friction on my sensitive inner arm skin as it’s vigorously rubbed back and forth. The rubber band tourniquet similarly irritates my skin, and though I don’t necessarily have a low pain tolerance per se, it feels like I can discriminate each individual cell layer that the needle penetrates and a searingly hot wave floods my whole body even when my antecubital space is touched gently or lovingly. SPD can transpose even soft touches to razor-blade like stabs. Somewhere in my mental survey of sensory insults, I’m brought back into awareness of the pre-op room and the nurses. “Ok, let’s try this again,” she says. “WHAT?” I exclaimed, “you said we were done!” “Oh no, honey. I just meant we were done trying to fix it.” Cue the waterworks. I freaked out. Like a petulant child, I started sobbing. “You said we were finished!” Needless to say, it was two more sticks until we were done, but I survived. I’m not proud of my behavior; far from it, I was filled with shame. As I hobbled on my crutches to the car, I vowed to myself to further research how to overcome this phobia.

I have. Extensively. But nothing has really resonated with me. Even the act of writing this post has made the multifactorial nature of this phobia more apparent to me. I did notice that Autism Speaks (which has its own pros and cons) has a comprehensive downloadable toolkit for parents to exercise with their autistic child prior to bloodwork. Unfortunately, even though I can be quite child-like in many regards, this is definitely geared toward a significantly younger demographic and therefore not useful for me. (If you are reading this and are parent of a young child, you may find it to be a helpful resource.) Becoming aware of the toolkit and assessing the amount of effort that must have gone into it did encourage me to imagine that there may be truth to my sensory processing issues exacerbating the experience for me. I know that the site they always collect from has some of the thinnest and most sensitive skin on my whole body so the cleansing with the alcoholic prep pad alone sends my system into overdrive before we’ve even begun, but I’ve been surprised how many phlebotomists seem reluctant or unwilling to try another site. They are the experts, so I am sure there is a valid justification for this (though I don’t know what), but the least offensive procedure I had was at the Celiac Disease Research Center at Columbia Presbyterian and they didn’t even ask-they just used my hand. It was more seamless and less excruciatingly stressful for me, by far. Who knows. I’m not a very adamant self-advocate when it comes to medical appointments, so perhaps I am less assertive and demonstrative of my self-informed position to adequately request the procedure modifications that would be most helpful for me. I’m working on my medical-appointment imposed unintentional and involuntary selective mutism. Clearly, I’m also working on trying to understand remedy my various challenges, though it’s not a quick nor easy process. At least I have my enjoyment for research and analysis on my side and plenty of opportunities to practice. For the record, I was too disappointed in my “performance” at this last blood draw to warrant getting the foxtail I want on Amazon, so hopefully the longer that carrot dangles in front of me, the more I’ll want to deserve it. (At the same time, part of my ADHD seems to be incredibly focused but short-lived interest in any one thing, so I’m not confident that won’t need updating as well). With my surgery pushed a few weeks back, I can guarantee there will be several updates to that wish list, more reasons I’ve uncovered for my anxiety, and hopefully a bevy of additional resources or facts to pacify (or at least inform) my problem.